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Jon Thompson

Publications and source records attributed to Jon Thompson.

9 recordsLinked to original sources
PubMed2006

Short bowel syndrome following bariatric surgical procedures.

BACKGROUND: Short bowel syndrome (SBS) is a potential postoperative complication that is occurring with increasing frequency after bariatric procedures (BP). As long-term follow-up data are available, unusual long-term complications are being identified. Our goal was to examine the mechanisms and outcomes of patients with SBS following BP. STUDY DESIGN: We retrospectively reviewed our SBS database for patients following BP and examined their demographics, indications for resection, clinical course, and outcomes. RESULTS: Eleven of 265 patients had SBS following BP. Mean age was 31 years (range 23 to 45). All were female. Operative procedures included open gastric bypass (GB) (n = 6), laproscopic GB (n = 2), jejunal-ileal bypass (JIB) (n = 1), revision of JIB (n = 1), and revision of open GB (n = 1). Five patients (45%) had internal hernia (IH). Two (18%) had bowel obstructions from adhesions that resulted in multiple resections. Two had mesenteric ischemia following revision of their BP. Two had mesenteric ischemia from a hypercoaguable state. Four SBS occurred in the initial 30-day postoperative period, 4 at 1 year, and 3 at greater than 10 years. Mean residual short bowel length was 54 cm (range 11.5 to 120 cm). All patients were on parenteral nutrition (PN) on presentation. Treatment included medical and surgical management. Currently 5 patients remain PN-dependent, 2 have died, and 4 are off PN after completing interstinal rehabilitation program/small bowel transplantation. CONCLUSIONS: Complications of GB can require massive small bowel resections leading to SBS. The risk does not diminish with time. Prevention of adhesions, closure of mesenteric defects, early diagnosis of internal hernias, and conservative resections for ischemia can reduce the risk.

Adult↗
PubMed2006

Pancreaticoduodenectomy for suspected malignancy: have advancements in radiographic imaging improved results?

BACKGROUND: The purpose of this study was to determine the impact of recent improvements in radiographic imaging in detecting malignant pancreatic disease. METHODS: A review of 132 patients undergoing pancreaticoduodenectomy for suspected malignancy from 1998 to 2005 was performed. Since 1998, patients were evaluated with helical computed tomography and since 2002 with multidetection scanners. RESULTS: Seventeen patients (12.9%) had nonneoplastic disease. The majority of these patients had chronic fibrosing pancreatitis (11 patients) and sclerosing lymphoplasmacytic pancreatitis (4 patients). The incidence of benign disease in patients undergoing resection from 1998 to 2001 (n = 45) was 8.9% in comparison to 14.9% for patients treated from 2002 to 2005 (n = 87, P = .39). CONCLUSION: Advances in imaging modalities made during the study period did not improve our ability to discriminate between benign inflammatory conditions and neoplastic disease. The inability to distinguish benign from neoplastic disease justifies the use of pancreaticoduodenectomy in the appropriate clinical setting.

Adult↗
PubMed2005

The Olivieri case: lessons for Australasia.

The case of Dr. Nancy Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc. vividly illustrates many of the issues central to contemporary health research and the safety of research participants. First, it exemplifies the financial and health stakes in such research. Second, it shows deficits in the ways in which research is governed. Finally, it was and remains relevant not only in Toronto but in communities across Canada and well beyond its borders because, absent appropriate policies, what happened in Toronto could have happened (and could well still happen) elsewhere. In Part One of this paper, we review the facts of the Olivieri case relevant to the issues we wish to highlight: first, the right of participants in a clinical trial to be informed of a risk that an investigator had identified during the course of the trial and the obligation of the investigator to inform participants (both her own and those of other investigators); and second, the obligation of institutions to protect and promote the well-being of research participants as well as academic freedom and research integrity, the obligations of research sponsors to inform participants, research regulators, and others about unforeseen risks, and the obligations of research regulators to ensure that participants are informed of unforeseen risks and to otherwise protect and promote research integrity. In Part Two, we relate these facts and issues to New Zealand and Australia. We also make detailed recommendations for changes to the various instruments used for the governance of research involving humans in Australasia.

Australia↗
PubMed2005

A multidisciplinary approach to the treatment of intestinal failure.

Intestinal failure is most commonly treated by the administration of total parenteral nutrition (TPN). In some patients, however, surgical therapy may increase the ability to use the intestine for nutrition and thereby decrease the complications of TPN therapy. A multidisciplinary comprehensive intestinal failure program was initiated at the University of Nebraska Medical Center in October 2000. Here we describe the surgical approaches to patients with short bowel syndrome and the subsequent impact on the need for TPN and on survival. Fifty patients (children=30, adults=20) underwent surgical procedures to restore intestinal continuity (n=5), repair enterocutaneous fistulas (n=5), resect dysmotile or strictured/obstructed bowel segments or mesenteric desmoid tumors (n=7), stricturoplasty (n=2), Bianchi tapering and lengthening (n=20), serial transverse enteroplasty (n=8), and other operations (n=8). Of these 50 patients, three patients did not require TPN after surgical intervention and seven had remnant small bowel anatomy that precluded TPN weaning (e.g., end duodenostomy) and were listed for transplantation or continued on full TPN support. Of the 40 remaining patients, most received the majority of calories from TPN at the time of referral, i.e., mean calories from TPN=90%. Subsequent to the surgical and medical therapy, 26 (65%) have been completely weaned off TPN. In addition, 10 had substantial decreases in their TPN requirements (i.e., from 85% of calories from TPN at onset decreased to a median 35% of required calories at most recent follow-up). Four patients remained on the same amount of TPN support. Four of the seven patients listed for transplantation underwent successful transplantation. Despite the complications of short bowel syndrome, 86% (n=43) of the patients are alive and well at a mean follow-up of 2 years. Patient deaths occurred primarily in those listed or eligible for transplantation and were related to advanced liver disease (n=3), gastrointestinal hemorrhage (n=1), or line sepsis (n=1). Two other patients died, one from influenza A infection and one from unknown cause at home, months after complete discontinuation of TPN. In this series of patients with short bowel syndrome, surgical intervention led to weaning or discontinuation of TPN support in 85% of patients. An organized multidisciplinary approach to the patient with short bowel syndrome is recommended.

Adolescent↗
PubMed2004

Short bowel syndrome after trauma.

PURPOSE: Traumatic injury to the intestine and its vasculature is a potential cause of short bowel syndrome (SBS). Our aim was to determine the incidence and mechanisms of traumatic injury to the bowel resulting in massive resection. METHODS: We reviewed the records of 196 adult patients evaluated with SBS over a 23-year period. RESULTS: Sixteen (8%) patients had SBS secondary to traumatic injury. Injury to the intestinal blood supply accounted for 81% (n = 13), and direct injury to the bowel wall accounted for the remaining 19% (n = 3). Nineteen associated injuries were present in 11 (67%) patients. CONCLUSION: Traumatic injury to the abdomen accounts for a small proportion of patients with SBS. These patients often have other associated injuries which might influence their outcome. Early diagnosis of vascular injury, use of second look procedures, appropriate resuscitation, and avoidance of all unnecessary resections may aid in prevention of this serious complication.

Abdominal Injuries↗
PubMed2002

Laparoscopic vasectomy: case report and review of the literature.

A 42-year-old man undergoing bilateral laparoscopic hernia repair requested vasectomy for family planning purposes. Bilateral vasectomy was done by a laparoscopic approach at the time of extraperitoneal hernia repair, and a separate scrotal incision was avoided. In addition to reporting a case of laparoscopic vasectomy, we review the published literature on this topic.

Adult↗